Effects on breathing mechanics and gas exchange of different inspiratory gas flow patterns in patients undergoing respirator treatment. In order to investigate the importance of different inspiratory gas flow patterns in respirator treatment, eight intensive care patients were studied with breathing mechanics and five patients also with gas exchange studies. Three different inspiratory gas flow patterns were tested in randomized sequences namely, accelerating, constant and decelerating flow. All three flow patterns were generated by the same respirator. No end-inspiratory pause was used. The results point to a favourable effect on breathing mechanics of a decelerating and a constant flow when compared with an accelerating flow type. However, when the total effects on gas distribution and lung perfusion were evaluated in the gas exchange studies, no significant differences were seen between the three flow patterns.


Arterial hypotension and hypoxaemia during total hip replacement: the importance of thromboplastic products, fat embolism and acrylic monomers. Thirteen patients submitted to total hip replacement surgery by the Charnley technique were studied. Operations were performed under epidural analgesia with the patients awake and breathing air. During the surgical procedure, the magnitude of tissue-thromboplastic activity, the amount of fat globules, the presence of bone marrow cells and the concentrations of acrylic monomers were determined in the pulmonary arterial blood. Simultaneously, arterial blood gases and blood pressure were monitored. Marked reductions of the arterial blood pressure and arterial oxygen tension occurred after impaction of the femoral prosthesis, and minor depressions appeared after insertion of the acetabular prosthesis. A significant correlation was found between the release of tissue-thromboplastic products into the pulmonary circulation, i.e., products that initiate intravascular coagulation and the circulatory and respiratory reactions. The pulmonary fat droplets, per se, seem to be of minor importance, and the release of acrylic monomers is probably of no importance for these reactions.


The effect of the short-acting barbiturate enibomal (Narcodorm) on systolic time intervals. The systolic time intervals were studied in 16 surgical patients without heart disease between 29 and 75 years of age by a non-invasive technique before and after an induction dose of enibomal (Narcodorm). The pre-injection period/left ventricular ejection time-ratio (PEP/LVET-ratio) increased between 8 and 60% and (1/PEP-2) decreased between 3 and 50%, indicating a reduction of myocardial contractility under the influence of enibomal. Factors responsible for circulatory depression during barbiturate anaesthesia are discussed.


Central and peripheral circulation immediately after pulmonary surgery as related to sympathodrenal activity. Catecholamine output and circulation were observed in connection with pulmonary surgery in one group of ten patients who were anaesthetized with halothane-N20-02-d-tubocurarine and who breathed spontaneously after operation. In another group of four patients who received a modified neurolept anaesthesia with phenoperidine-N2O-O2-d-tubocurarine and who were mechanically ventilated also after operation, catecholamine output and temperature were observed. In both patient groups, catecholamine output was normal during iperation. Adrenaline output increased by 400% the first postoperative hours, while noradrenaline output remained normal. Thereafter, noradrenaline output increased, while adrenaline output started to decrease. A subnormal body temperature was seen at the end of the operation. In two patients from the neurolept group, adrenaline output and temperature were recorded hour by hour; maximal adrenaline output concided with maximal temperature rise. In the patients from the halothane group, the pstoperative change in foot, calf and forearm blood flow correlated well with the change in catecholamine output. The central circulatory response to the symptahoadrenal stimulation was, however, found to be less pronounced than is ordinarily seen.


Effects of thiopental (Trapanal) on coronary blood flow and myocardial metabolism in man. The influence of thiopental (Trapanal) on coronary blood flow (MPF), myocardial oxygen consumption (MVO2), and general haemodynamics was investigated in seven patients without heart disease. Besides measurement of MBF, the amount of substrates (glucose, lactate, pyruvate and free fatty acids (FFA) was also determined in arterial and coronary sinus blood samples. Thiopental was given intravenously in a mean dose of 4 mg/kg b,w, MBF was measured by means of the argon method. After injection of thiopental, all seven patients showed a significant increase of MBF and MVO2, a fact which can essentially be explained by the increase of heart rate. The effects of thiopental on arterial concentrations, arterior-coronary substrate differences, myocardial uptake, and O2-extraction ratio of the different substrates are discussed.


Effect of dihydroergotamine on perpheral circulation during epidural anaesthesia in man. The effect of intravenous administration of dihydroergotamine (DHE) on regional blood flow in the forearm and calf after pharmacological nerve blockade of the lower body induced by epidural anaesthesia has been studied in 13 subjects. After anaesthesia, DHE induced a significant increase in blood flow in the forearm with intact innervation and a significant decrease in blood flow in the nerve-blocked calf. On the average, the arterial blood pressure increased slightly. The calculated local vascular resistance increased in the nerve-blocked calf, probably due to a direct myogenic constrictive effect of DHE. In the intact forearm, local vascular resistance decreased. The results indicate that DHE exerts a complex effect on resistance vessels in addition to its well-known effect on the capacitance vessels.


Effects on breathing mechanics and gas exchange of different inspiratory gas flow patterns during anaesthesia. Ten patients without known cardiac or respiratory disease were investigated with breathing mechanics and gas exchange studies during anaesthesia and artifical ventilation. The effects of three different inspiratory gas flow patterns, namely, accelerating, constant and decelerating flows were studied. A decelerating flow resulted in an increase of total compliance when compared to an accelerating or a constant flow. However, at the same time, there was an increase in physiological dead space and a decrease in alveolar ventilation with a decelerating flow compared to an accelerating flow. These results seem to indicate an improved gas distribution in the greater airways with a decelerating flow pattern, but when the total effects of gas exchange were judged, the greatest benefits were with an accelerating flow.


Concentration of bupivacaine in arterial and venous plasma after epidural anaesthesia in man and after intramuscular administration in dog. The arteriovenous concentration difference of bupivacaine in plasma after epidural injection in man and after intramuscular injection in dog was studied. In man, arterial concentration was higher than peripheral venous ocncentration during an initial period of about 30 min, after which time period venous and arterial concentrations became fairly similar. Comparable results were obtained in the animal experiments. In addition, the experiments in dog indicated that the concentration of bupivacaine was fairly similar in central venous plasma and arterial plasma, but higher than the peripheral venous plasma concentration. These factors have to be taken into consideration when toxicological studies of local anaesthetic drugs are made.


Complications to tracheostomy and long-term intubation: a follow-up study. Hospital records of 79 patients treated with tracheostomy or long-term intubation from 1969 to 1971 were reviewed, and the 43 surviving patients were examined by laryngoscopy, x-ray and spirometry for complications subsequent to these treatments. Early complications included one tube occlusion and one case of postextubation stridor in each group, one dislocated tube, one bilateral pneumothorax, and one case of fatal innominate arterial hemorrhage in the tracheostomy group, and two cases of atelectasis in the long-term intubation group. Necropsy findings included necrotic ulcers in the larynx of intubated patients and eroded tracheal mucosa in both groups. Late complications in surviving patients were prolonged hoarseness in six patients treated with prolonged intubation, two of whom had also had tracheostomy. Radiologically verified tracheal stenosis (40-60%), four at the stoma level and one at the cuff level, all occurred in the tracheostomy group.


Effect of controlled halothane anaesthesia on splanchnic blood flow and cardiac output in the dog. Effects of halothane anaesthesia on aplanchnic blood flow and cardiac output were studied in six dogs. Blood flows in the hepatic artery, the superior mesenteric artery and the portal vein were measured electromagnetically. Cardiac output was measured by thermodilution. Depth of anaesthesia, ventilation, acid-base state and body temperature were controlled. Cardiac output and blood flows in the hepatic artery, the superior mesenteric artery and the portal vein decreased significantly to 73%, 54%, 59% and 60% of control values, respectively. Total peripheral vascular resistance decreased significantly, while mesenteric and portal resistance remained essentially unchanged and hepatic arterial resistance showed a significant increase. It is suggested that the difference between the various vascular responses may be caused by a differentiated release from baroreceptor inhibition in various parts of the bulbar vasomotor center.


Maternal and fetal responses to halothane in pregnant monkeys. Maternal cardiac output, blood pressure, heart rate, fetal blood pressure, heart rate and respiratory blood gases, and uterine blood flow were measured in six pregnant monkeys during halothane-nitrous oxide and oxygen anesthesia and compared to theses same parameters observed during nitrous oxide and oxygen anesthesia. Halothane 1.5% was associated with a decrease in maternal arterial pressure (54%), heart rate (10%), cardiac output (17%), total peripheral resistance (40%), and uterine blood flow (38%). Mean fetal heart rate decreased 18% and mean fetal blood pressure 22%. These changes in fetal hemodynamics were probably related to a direct depression of the fetal cardiovascular system and its usual compensatory mechanism as well as the fetal asphyxia secondary to the decrease in uterine blood flow.


The embryonic and postnatal growth of rat and mouse. III. growth of the whole animal in the puberty, adult, and senescence phases in two inbred mouse strains (cpb-s and kba/2). Exponential growth, sudden changes in the growth rate, and a model for the regulation of the mitotic rate. 1. The growth model forumlated for prenatal and postnatal growth up to the middle of the puberty phase seems to be valid for the later postnatal phases as well, including adulthood and senescence. 2. In this model, growth consists of phases with exponential growth (constant specific growth rate) separated by sudden changes in the rate. 3. In the period described here, 7 phases can be distinguished, beginning with puberty (phase IV) and ending with senescence (phase X). 4. In 4 of these phases the growth rate does not differ significantly between the four groups of mice used. In the other 3 phases there are no differences between three of the groups but the fourth, one of the sexes of the CPB-S strain, differs very definitely from the rest. 5. Absence of growth occurred in some phases in one of the groups. 6. Some of the phases do not occur in all individual animals; this holds especially for phase VIII, which occurred in only about 25% of the animals. 7. The 'growth constants' postulated in Part I and now studied in the individual mice, tend to have a value of about 2. A theoretical model is described for the regulation of the mitotic rate giving 'growth constants' of about the same numerical value.


Comparative microscopical study of the gall bladder mucosa. The gall bladder from 6 Psammophis sibilans, 10 Bufo regularis and 10 Albino mice were extracted and prepared for microscopic examination. It was found that the mucosa of Psammophis sibilans consisted of ovoid and polygonal cells which were occasionally binucleated cells with darkly stained nuclei and occasionally pear-shaped cells with vesicular nuclei and fine processes. These cells were arranged in three layers. Apossible explanation for the different types of cells encountered and their arrangement was given. The gall bladder mucosa of Bufo regularis and Albino mouse were thrown into folds covered with simple columnar epithelium. However, the epithelium of the frog was higher than that of the mouse, with the nuclei situated midway between basement membrane and the lumen. Vacuolated cells were detected in the gall bladder mucosa of the mouse. The significance of the mucosal folds was discussed.


Ontogenic growth changes of the skull base in four genera of nonhuman primates. Cross-sectional studies of the degree of the cranial base flexion were carried out in infant, juvenile and adult skulls in four genera of nonhuman primates (P. paniscus, H. lar, P. urinus, and M. mullatta). The cephalometric observations of the cranial base included linear and angular measurements of each specimen. The data obtained in this study showed that the anterior portion of the cranial base exhibits a significant shortening trend as the mammalian evolutionary scale ascends. Moreover, the growth pattern of the anterior portion of the skull base follows that of the facial bony structures. The ontogenic growth changes of the posterior portion of the skull base follows the growth pattern of the endocranial cavity. The significant trend of elongation in this area directly contributes to the posterior migration of the foramen magnum. The magnitude of these growth changes decreases as the evolutionary scale ascends. The angular measurements of the cranial flexion showed a less obtuse cranial base angle in young specimens and the ones higher on the mammalian scale. The skull kyphosis was less pronounced in these specimens and the anatomical features of the cranial base were more humanlike, including the balance of the head expressed by the position of the foramen magnum.


Review of the evolution and phylogeny of the mammalian tongue. Evolution of the mammalian tongue has been characterized by a number of extensive structural adaptations for the highly specialized functions which various tongues perform. Variations in shape, epithelium, muscle arrangement and mechanisms of lingual stiffening are described, and the possible way in which such changes have occurred is discussed. The review also shows that a study of the tongue's structure in conjunction with other anatomical features may serve as a useful indicator of an animal's habits and diet and provide important information for taxonomic purpose.


[Form and development of the human fetal subarachnoid cistern]. The development and form of the human fetal subarachnoid spaces have been elucidated by reconstruction (34 mm CRL fetus) and by plastic casts (several 20-30 cm CRL fetuses). Equivalents of adult cisterns are present in the young fetus. In older fetuses the cisternal shape is of adult type. It is suggested that pressure from the growing brain produces tension in the arachnoid mesenchyme and determines the initial orientation of the endo-ecto-meningeal limiting membrane. The fluid-filled subarachnoid spaces and the fetal brain together form a composite structural unit probably defining the configuration of the fetal head capsule. Prospective sutures develop over the inner ridges of the fetal dura. However, the lambda suture and the associated base of the tentorium eventually separate.


Functional asymmetry in the face.

Functional asymmetry in the face. The possible existence of one-sided dominance in the face, similar to the phenomena of handedness and footedness, has been investigated by studying smiling pattern, movements of the angles of mouth, winking, platysma contraction, raising and everting the upper lip with dilatation of the nostril, and vertical wrinkling of the forehead, on 300 right-handed and 30 left-handed persons. The conclusions are as follows: 1. The large majority of persons investigated do not use the two sides of face equally. 2. Facial ambilaterality is a rare feature. 3. There is no clear-cut correlation between handedness and the dominant side of the face. 4. The greater percentage (58.66%) of right-handed persons show a left-sided smile and find it more convenient to perform almost all exercises with the left side of the face. A still greater percentage (73.33%) of left-handed persons shows a right-sided smile and a better performance of all exercises with the right side of the face. The contralateral relationship of handedness to the dominant side of the face is significant in the right-handed and more so, in the left-handed persons.


Blood vessels and excretory apparatus of the kidney in some wild animals. On 110 preparations of the kidney in some wild animals (hare, fox, wolf, bear, boar and chamois), the blood vessels and the excretory apparatus were studied by dissection, injection-corrosion and microscope. Only the bear has a markedly split kidney, whereas the kidneys of the other animals are unsplit. In the fox there is an obvious split of the renal artery into anterior and posterior branches which supply the anterior and posterior portion, respectively, of the renal parenchyma, being separated from each other, so that we may speak of an anterior and posterior kidney. In the fox, wolf, hare and chamois the interlobar arteries pass through the renal calices in a loop composed of adipose tissue, invested by the epithelium of the renal calyx. The renculi of the bear kidney show complete autonomy in relation to the blood vessels as well as in relation to the excretory apparatus. The relation of the surface of the excretory apparatus to the whole kidney was studied. Thus we have found the fox to have relatively the largest excretory apparatus, whose surface amounts to 31% of the whole kidney. In the remainder of the animals investigated this percentage is considerably less, ranging from 21.7% (boar) to 26.7% (bear).


Histochemistry of oxidative enzymes in the neuroglia in course of myelination. The histoenzymic pattern of oxidative enzymes (G-6-PDH, G-PDH, ICDH, SDH, HBDH, NADH-2:tetrazolium dehydrogenase) was investigated in the developing neuroglia of rabbit brains, with special regard to the period of myelinogenesis. The obtained results lead to following conclusions: (1) During the early period of postnatal development there is maximal oxidative enzyme activity in ependymal cells, somewhat less reactive are the undifferentiated matrix cells and the differentiating cells of the mantle layer. No distinction can be made between the response of spongio- and neuroblasts. (2) Distinctly increased oxidoreductase activity, as compared to the early period of postnatal development, is demonstrated by the differentiating cells of myelination gliosis, no prevalence being demonstrable for enzymes of the particular metabolic pathways (pentose shunt, glycolysis or Krebs cycle). (3) G-6-PDH, G-PDH and oxidoreductases acting within the citric acid cycle are demonstrable only in single cells of the interfascicular oligodendroglia of adult rabbit brains, while almost all cells exhibit appreciable activity of HBDH and NADH-2 tetrazolium dehydrogenase.


Histochemical observations on the mucins of the gastrointestinal tract in the toad (Bufo melanostictus). The pattern of mucin secretion of the gastrointestinal tract of the toad (B. melanostictus) was investigated by histochemical methods. The goblet cells of the oesophagus secreted mainly acid mucins which were sialomucins, while the cells lining the surface of the stomach produced neutral mucins only. Goblet cells of the small intestine and cloaca secreted acid mucins, which were predominently sulphated mucins.


Studies on ectopic granule cells in the cerebellar cortex. III. An investigation into the restoration of the external granular layer after partial destruction. In order to strengthen a hypothesis concerning the occurrence of ectopic granule cells, one of the assumptions made was tested systematically. The reaction of the EGL to partial destruction by various single doses by hydroxyurea at various ages was followed. Under all conditions examined, re-population of the EGL takes place--rapidly after lower doses, slowly after high doses of HU. The phenomena observed are discussed with a view on the hypothesis mentioned. Re-population is beneficial, but may itself be a major pathogenetic factor in certain developmental malformations by upsetting the "time-schedule". The results are also of potential interest for an analysis of the regulation of normal cerebellar morphogenesis.


An unusual type of infantile lipofuscinosis. The case of a child is described who at the age of 2 years showed the first evidence of a developing neurological disease. Within a couple of years, profound mental retardation and severe motor deficit with spastic tetraplegia became established. No seizures and no pigmentation of the retina were observed. The condition remained practically unchanged for some 8 years and the patient died at 12 years of age of terminal bronchopneumonia. At autopsy there was conspicuous diffuse atrophy of the brain. The cerebral cortex was particularly involved. Most of the cortical neurons were destroyed and neuroglia showed abundant proliferation. The few remaining neurons contained inclusion material which was identified as lipofuscin. Noticeable cedifferences from the various types of amaurotic idiocies are noted and similarities to a case of lipidosis recently reported from Finland are suggested.


The occurrence of dark neurons in the normal and deafferentated lateral vestibular nucleus in the rat: observations by light and electron microscopy. The lateral vestibular nucleus was studied by light and electron microscopy in normal rats as well as in rats in which the anterior cerebellar vermis was destroyed. Dark neurons were seen in many of the operated rats but were rarely found in normal control animals. The dark neurons were not seen in adjacent nuclei. In additional rats, it was found that anoxia, extra anaesthetic, postmortem rough handling, and sham operations did not increase the frequency of dark neurons. These data indicate that dark neurons might not always be artifactual and that the lateral vestibular nucleus appears to be a focal point for their occurrence.


Wernicke's encephalopathy: an experimental study in the rhesus monkey. Experimental Wernicke's encephalopathy, induced in rhesus monkeys with a diet lacking thiamine (vitamin B1), is characterized by cavitary necrosis of the striatum as well as a microvacuolar periventricular lesion of the brain stem such as occurs in man. With high resolution light microscopy and electron microscopy, the primary structural alteration in the brain stem lesion, and probably also in the striatum, appears to be that of widespread "blister" formation due to splitting of myelin at the intraperiod line. Microvascular alterations were minimal, even in the most severely affected regions. It is the myelin blisters which give rise to the spongy texture of the neuropil. A similar splitting of myelin has been described in several other experimental encephalopathies, and it is probable that it also occurs in Wernicke's encephalopathy in man.


Clinico-pathological correlations in a case of traumatic pan-hypopituitarism. A case of post-traumatic chronic pan-hypopituitarism in a 22 year old man is reported. Post-mortem examination revealed gliosis of the posterior hypothalamus, sclerosis of the neuro-hypophysis, cellular atrophy of the adenohypophysis, with relative hyperplasia of the basophil cells, atrophy of the endocrine target glands. Clinical and morphological findings are correlated and discussed.


The large dense core vesicle: a normal organelle of the central nervous system myelinated axon. Large dense core vesicles (LDCV) were found frequently enough in normal guinea pig central white matter, basis pontis and spinal cord posterior columns to be regarded as a normal organelle. A review of studies of LDCV and dense core particles (DCP), which have a different cytological localization and appear to be associated with a variety of diseases, suggests that they are the same, and hence remarkedly ubiquitous. LDCV should no longer be regarded as a type of synaptic vesicle, but as an incompetely defined organelle common to many cell types.


Effect of centrifugation on amniotic fluid phospolipid recovery. Amniotic fluid lecithin and sphingomyelin were determined quantitatively in 33 samples obtained throughout the last trimester. Each sample was divided into three parts and each part was centrifuged at different relative forces prior to extraction. It is shown that centrifugation always removes considerable amounts of both lecithin and sphingomyelin from the supernatant towards the end of pregnancy, but very little at the beginning of the last trimester. The fatty acid composition of amniotic fluid lecithin, studied by gas liquid chromatography, indicate that surface active lecithin is lost by centrifugation of the fluid prior to extraction.


The hazards of vacuum aspiration in late first trimester abortions. The incidence of somatic complications in connection with legal termination of pregnancy by vacuum aspiration was analysed in 1,123 hospital patients. Special attention was paid to complication rates in relation to gestational age. It was found that the incidence of major uterine haemorrhage increased with gestational period, being unexpectedly high in the 12th week. When anaesthesia was supplemented with halothane there was a significantly higher incidence of uterine haemorrhage that when this anaesthetic was avoided. The results indicate that strict principles for the operation procedure are mandatory to reduce blood loss and other complications. It is suggested that the end of the 12th week should not be considered as a "magic" time limit for vaccum aspiration but that the policy should aim at early intervention, preferably before the end of the 10th week. In the event of late first trimester abortions or "border line" cases it is of advantage to administer prostaglandin extra-amniotically for pre-operative dilatation of the cervix.


Fibrinogen-fibrin degradation products in menstrual blood from women with normal and excessive menstrual losses. Fibrinogen-fibrin degradation products, FDP, in menstrual blood during the first three days of menstrual blood during the first three days of menstruation have been investigated. Two groups of women were studied, those with normal menstrual blood loss (15 women, mean loss 30 ml, range 8-60 ml) and those with menorrhagia (14 women, mean loss 222 ml, range 107-729 ml). The following results were obtained: 1). The FDP concentrations decreased during menstruation in both groups. 2). The FDP concentrations in the two were compared for each day of the menstrual period. No differences were found between the two groups. A possible explanation of the results is given: there is a higher rate of coagulation and fibrinolysis in the endometrium of women with menorrhagia compared with women with normal blood losses. The hypothesis is supported by results of studies in which tranexamic is supported by results of studies in which tranexamic acid, an inhibitor of fibrinolysis, was given to reduce the menstrual blood loss. 3). The FDP excretion patterns differed from women to women. There were no consistent differences between the menorrhagic and the control group.


Serum levels of oestradiol and progesterone during administration of prostaglandin F2alpha for induction of abortion and labour. Prostaglandin F2alpha was used to induce abortion or labour in 84 women between the 11th and 44th weeks of pregnancy. Three different routes of administration were used, intravenous, extra-amniotic, and intra-amniotic. The extra-amniotic infusion of prostaglandin F2alpha produced a faster response than the other two routes. Less than one-third of the dose used in the intra-amniotic group was required in the extra-amniotic group for a complete evacuation of the uterus. Vomiting and diarrhoea occurred in 40% of the women in the intra- and extra-amniotic group, while the frequency was 88% in the intravenous group. Serum levels of progesterone and oestradiol decreased in accordance with the pattern found during spontaneous deliveries. The effect of prostaglandin F2alpha on the myometrium does not appear to be mediated via changes in the blood levels of progesterone or oestradiol.


Outcome of term breech delivery in primigravidae. a feto peivicbreech index. Analysis of 340 term breech presentations in primigravidas showed a corrected perinatal mortality of 1.5%; the elective cesarean section rate was 15%. The incidence of complicated labour, defined in the study, was analyzed with regard to different parameters, e.g. X-ray pelvimetry data in all 340 cases. Complicated labour in vaginal deliveries markedly increased with increasing fetal weight (p less than 0.001) and decreasing pelvic capacity (p less than 0.001). In each case the fetal weight and smallest pelvimetry data were given score points and the sum of these was called the Feto Pelvic Breech Index, which was correlated to the incidence of complicated labour. By using this index the mortality and the routine use of elective cesarean section. The prognostic methods available to detect feto-pelvic disproportion are discussed.


Urge incontinence in women.

Urge incontinence in women. A survey has been presented of the author's personal methods to treat urge incontinence in women caused by neurogenic disturbances or by urethritis. Denervation of the bladder by unilateral or bilateral resection of the inferior hypogastric plexus is used for neurogenic disturbances with uninhibited bladder contractions or hypertonic bladders and in cases of interstitial cystitis, if a preoperative blockade with local anaesthesia has given a favourable result. Urethral diverticula are extirpated. Urethritis is treated with careful dilatation of the uretha and massage in combination with local treatment of the mucosa with 1% solution of silver nitrate. In cases with a narrow urethral orifice a meatotomy is made. Women with wide external orifice and recurrent urethritis following intercourse are operated upon. A structure similar to the frenulum of the prepuce in the male is constructed, which closes the orifice at the introduction of the penis.


Serotonin, 5-hiaa, total estrogen and pregnanediol excretion in urine during therapeutic saline abortion. In 24 patients, who underwent therapeutic abortion for various reasons between the 17th and 26th week of pregnancy, urinary excretion of serotonin, 5-HIAA, total estrogens, and pregnanediol were measured before, during and after the intra-amniotic injection of hypertonic saline. 20% hypertonic saline solution (160-500 ml) was given by transabdominal injection over a period of 5 min. The four hormones or metabolites were measured during six periods: I; 12-24 hrs, and II: 0-12 hrs before saline administration, III: 0-12 hrs after saline administration, IV: 0-12 hrs during aborion, V: 0-12 hrs and VI: 12-24 hrs after abortion. The results point to the active participation of serotonin in the process of fetal expulsion, as serotonin was increased by over 100% (from 20-22 to 43-47 mu-g/12 hrs) during periods III-IV, and its metabolite 5-HIAA, too, increased by nearly 60% (from 2.4-2.5 to 3.3-3.9 mg/12 hrs). They decreased during the post-abortive periods V-VI. On the other hand, total estrogens decreased only slowly, but continuously, during all 6 periods (4.9, 4.3, 3.4, 3.1, 1.8 and 1.4 mg/12 hrs). Pregnanediol, beginning with 12 mg/12 hrs showed a slight increase during periods III-IV (14.5 and 15.6 mg/12 hrs) and a decrease during periods V-VI (8.0 and 5.8 mg/12 hrs). These findings are interpreted as indicating the disruption of feto-placental function affecting estrogens during periods III-VI. They might demonstrate an accelerated hydrogenation of progesterone into pregnanediol during periods III-IV, followed by a sharp decreased in progesterone/pregnanediol production during periods V-VI.


Effects of terbutaline on human uterine motility at term. The effects of the selective beta-2-receptor stimulator terbutaline on the activity of gravid, human myometrium were investigated in vitro and in vivo, before and after administration of different beta-receptor blockers. Terbutaline, 0.2-1.0 mu-g/ml, inhibited the spontaneous contractile activity of isolated strips of myometrium. This effect was unaffected by the selective beta-a-receptor blockers practolol, 1 mu-g/ml, and H 93/26, 1 mu-g/ml. However, the non-selective blocker propranolol, 0.1 mu-g/ml, completely inhibited the terbutaline effects. The in vitro effects of terbutaline could be correlated with findings in vivo. Intra-uterine pressure was recorded in 4 pregnant women at term. Infusion of terbutaline, 10-15 mu-g/min, for 20-40 min, effectively inhibited both spontaneous and oxytocin-stimulated uterine activity. There was a moderate increase in maternal heart rate, but no consistent effect on maternal blood pressure. Fetal heart rate was little affected. The uterine effects of terbuline were not influenced by practolol, 5-20 mg i.v., but completely inhibited by propranolol, 1-2 mg i.v. The results suggest that terbutaline inhibits uterine motility by effects on uterine beta-2-receptors and that it can be given in clinically effective doses without adverse circulatory effects on mother or fetus.


The effect of a copper iud and "inert" iuds on the incorporation of 3-h-thymidine and 5-3-h-uridine into the endometrium of the rabbit after stimulation with human chorionic gonadotropin. The present investigation studied the influence of different types of intra-uterine devices (IUDs) especially that of a copper IUD, on the incorporation of 3-H-thymidine and 5-3-H-uridine into the endometrium of the rabbit. "Inert" IUD. In non-stimulated rabbits, the incorporation of 3-H-thymidine was increased in the copper influenced horn. The incorporation of 3H-thymidine in control and Cu-IUD-containing horns reached a maximum at 48 hours after HCG stimulation, but was significantly lower in the copper-containing horn than in the control horn. On the fifth day of pseudopregnancy, the incorporation of 3-H-thymidine was significantly higher in the copper IUD-containing horn. The total amount of DNA in the endometrium increased during early pseudopregnancy, but this increase was markedly reduced in the presence of copper. The copper IUD had no influence on the rate of incorporation of 5-3-H-uridine in non-stimulated rabbits, whereas it caused a higher incorporation on the fifth day of pseudopregnancy.


Demonstration of boundary lubrication by synovial fluid. An account is given of an oscillatory rotating friction measurement apparatus which can be used for demonstration of boundary lubrication by synovial fluid when rubber and glass are employed as rubbing surfaces. A technical description of the apparatus is given. The greatest importance is placed on getting the apparatus to demonstrate reproducible results when saline and normal bovine synovial fluid are used as lubricant. The greatest variations are caused by differences in the cleaning of the rubber and in its tension. On the basis of bovine synovial fluid from ten different hock joints investigations were made of individual variations and changes occurring during storage at 4 degrees C. The individual variations were found to be of no importance; a decrease in the lubricating effect was observed only after storage for two months. Addition of trypsin confirmed that boundary lubrication by synovial fluid can be related to the protein component. The conclusion is that the apparatus is considered suitable for clinical investigations of boundary lubrication in connection with different joint diseases.


Difference in leg length in children with coxa plana during and after treatment using unilateral unloading. In unilateral coxa plana a shortening of the affected leg can often be found. This shortening affects not only the caput-collum part of the femur but also the other parts of the femur and the tibia. In this study, however, the immobilization of the affected leg seemed to be the main reason for the observed difference in the leg length. Children who had not unloaded their affected leg as carefully as they should proved to have a smaller difference in leg length than those who had unloaded their affected leg according to the instructions. On the other hand compensatory growth of the affected leg was found when both legs were again taking weight. The difference in the leg length was significantly reduced one year after the completion of the treatment.


Use of ultrasound to detect fat emboli during total hip replacement. Use of the Doppler principle with an ultrasound flowmeter provided a method of detecting fat emboli during total hip replacement. A measure of the quantity of fat emboli and when the embolism occurs during the operative procedure is possible with this method. By the use of a suction catheter inserted in the intramedullary canal or the placement of large drill holes in the lateral cortex of the femur the amount of fat released into the venous circulation can be reduced. Although no definite signature could be obtained for the audible "chirps" by energy density spectrum analysis the observer could readily distinguish these chirps from the burbling noise produced by air emboli. Ultrasound is an easy, noninvasive and reliable technique for detecting fat emboli during total hip replacement.


Autogenous transplantation of apophyseal cartilage to osteochondral defects of joints. 35S was administered to 20 puppies which had been exposed to transplantation of osteochondral apophyseal transplants from the iliac crest to defects of the femoral condyles. Some transplants were implanted into defects within the joint surfaces whereas others were implanted outside the joint surfaces. An autoradiographic study was performed to assess the functional vitality of the transplanted cartilage at varying intervals up to 14 months. This study further necessitated an investigation of the normal pattern of incorporation of 35S in the iliac crest.  The studies revealed that the incorporation of 35S within the apophysis of the iliac crest was similar to that seen within pressure epiphyses, being heaviest in the proliferating and hypertrophying cells in the growth plate and around the secondary centre of ossification. The increased turnover of sulphur around the secondary centre of ossification declined, however, when the initial stage of the ossification was passed and when hypertrophy of cartilage cells was no longer seen. Ossification then took place without intensified production of organic sulphur-containing compounds in this region. The study further showed that apophyseal cartilage was still able to incorporate 35S following transplantation to the mentioned defects, except in some basal central areas adjacent to the metaphyseal bone. These findings suggested that the cartilage not only survived, but also preserved its capacity for synthetizing sulphur-containing compounds, probably chondroitin sulphate.


Traumatic aneurysm of the common femoral artery after hip endoprosthesis. A case with a rare arterial trauma after a femoral head replacement with a Christiansen prosthesis is presented. The common femoral artery was penetrated by the tip of a Homan speculum and a false aneurysm developed.


Performance of bk amputees using ptb prostheses. A below-knee amputee is generally known to achieve a close-to-normal performance level, with the patellar-tendon-bearing method of stump fitting. This was confirmed by an ergonomic investigation on ten below-knee amputees, fitted with PTB prostheses. The test group subjects were given two static tests, two dynamic tests and one exercise tolerance test, during which their oxygen consumptions, pulmonary ventilations, energy expenditures and peak heart rates were measured. The performance of the test subjects were compared with that of a control group consisting of sixteen normal, healthy, individuals. The percentage increases in the values of the biomechanical parameters of the test subjects, over those of the control group, were found to be justified and thus natural to the below-knee amputee-PTB prosthesis system. The ergonomic study has not yielded information regarding the biomechanical efficacy of the PTB prosthesis, but it has also shown that the amputees fitted with such prostheses can take up, without any undue extra effort and metabolic cost, industrial  occupations of the moderately heavy kind.


Pathological anatomy of the aging meniscus. In 21 autopsy subjects and 25 anatomical cadavers, both knee joints were dissected extensively to find: a) degenerative changes in the menisci of knee joints, especially horizontal tears and b) associated degenerative changes in the articular surfaces of the knee joint, in order to attempt a correlation between the two lesions. Thirty-nine horizontal tears of the meniscus in 21 patients were found, of which 32 were in the medial meniscus. There was no articular damage visible in three, minimal in eight, moderate in seven and severe in three subjects. The highest incidence was in the seventh and eighth decades with black males showing a slight preponderance. The degenerative meniscus with a horizontal tear is a part of the overall degenerative process in the knee joint and should be treated as such.


Tibial osteotomy for osteoarthrosis of the knee. Forty-five knees with tibial osteotomy for osteoarthrosis were studied at 5 to 10 years following surgery. Twenty-seven were graded excellent, eight good and ten poor. The best results were found in knees which maintained a Femoro-Tibial angle of 163 degrees--180 degrees whereas the poor results were associated with either under-correction at operation or late recurrence of deformity. The latter was closely related to pain. Provided that the initial deformity is adequately corrected and maintained, tibial osteotomy for osteoarthrosis of the knee gives good results which can last up to 10 years.


Congenital clubfoot.

Congenital clubfoot. A series of 58 children with 75 idiopathic congenital clubfeet is presented. Early soft tissue release was performed in 77 per cent. The main purpose of the study was to clarify the causes of postoperative relapse. The results were poor in 12 feet, 11 (19 per cent) were reoperated. On re-evaluation of the "poor" cases we found severe social problems involved, including parental neglect.


Effect of cortisone and an anabolic steroid upon plasma hydroxyproline during fracture healing in rabbits. The effect of cortisone and an anabolic steroid on plasma hydroxyproline (HOP) was investigated in young male rabbits, following operative fracture of the radius. The action of these hormones was studied in three groups of animals, a cortisone (hydrocortisone sodium succinate 5mg/kg every day), an anabolic (norandronolone-19-phenylpropionate 5 mg/kg every other day) and a cortisone plus anabolic treated group. A fourth group of animals served as controls. Plasma HOP was found to increase during the fracture healing in control animals, particularly in the first week and during callus remodelling. Cortisone produced elevation of HOP level during the first two weeks followed by a decrease to low normal values. Animals treated with the anabolic did not present the initial rise but a sustained increase during callus remodelling. When both the anabolic and cortisone were administered, a curve similar to that of cortisone-treated animals was obtained. The initial increase of HOP is attributed to bone destruction and to a lesser degree to synchronous bone formation at the site of the fracture. This catabolic process seems to be enhanced by cortisone and inhibited by the anabolic. When, however, the two hormones are given together the protective anticatabolic effect of the anabolic is almost abolished.


Physical work performed by surgeons during orthopaedic operations. Four surgeons participated in a study which aimed to demonstrate the physical work load during operations. Maximal oxygen uptake and maximum heart rate were determined by using the Douglas bag technique and recording the heart rate during the tests. By working at two submaximal work loads, heart rate was recorded and miximal oxygen uptake was determined indirectly. Using telemetry, heart rate was recorded during operation, and the mean oxygen uptake was determined. In 90 per cent of all operations the surgeons were working at a level of 20 to 30 per cent of their maximal aerobic capacity. There was an increase in body temperature and a decrease of body weight after all operations. In long lasting operations a decrease of grip force was noted.


Characterization of bone cements.

Characterization of bone cements. Properties of acrylic bone cements during and after curing were determined for three brands of bone cement. Curing time and consistency were chosen for the characterization of the handling and working behavior of these materials. The performance of bone cements after curing may be related amongst other things to the following properties: water resorption, solubility/disintegration, flexural modulus of elasticity, yield stress, proportional limit, flexural strength and impact strength. Methods to determine these handling and material properties are described. The influence of radiopacifying and antibiotic additives on these properties is evaluated as well as the influence of porosity on flexural strength and impact strength. The results indicate that considerable differences in the handling properties occur. The material properties of the three brands tested do not show marked differences. Radiopacifying and antibiotic additives appear to have a negative effect on material properties; the effect of porosity as it develops during curing under simulated clinical conditions is more pronounced.


The normal and pathological mobility of the metacarpo-phalangeal joint. The pathological mobility of the metacarpo-phalangeal joints of 100 patients affected by rheumatoid arthritis was studied, and the results were analysed and compared with the results obtained in a control non-rheumatoid group. This report seems to suggest that rheumatoid metacarpo-phalangeal joints become more lax the longer the rheumatoid disease has been present. However, when there is marked local involvement of the joint this hyperlaxity cannot be proven because of pain and/or mechanical blockage.


Long-term observations on the loss of bone mineral following colles' fracture. Seventy-four women were studied at various points in time between 1 month and 12 years after a fracture of the distal end of the radius--Colles' fracture. In 50 cases the maximum loss of bone after fracture was considered to have taken place in that more than 4 months had elapsed since the accident. The bone mineral content was measured in both forearms with gamma absorptiometry. It was demonstrated that the degree of post-traumatic osteoporosis, calculated as the difference between the values obtained for the injured and the uninjured arms, decreased with time. The difference between the arms was greater in peri- and early postmenopausal and in very old women suggesting that these groups had lost more bone and/or been less able to restore lost mineral with time.


Diphtheroid infection of the cervical spine. A unique case in which cervical osteomyelitis was caused by a diphtheroid is reported and the previously recorded clinical infections due to similar organisms are briefly reviewed.


A study of height, weight and menarche in girls with idiopathic structural scoliosis. In a series of girls with idiopathic structural scoliosis the height, weight and age at menarche were studied. It was found that the girls were on the average taller than a control population and that except for the most severe cases their height was greater even if the trunk shortening caused by the deformity was not accounted for. The girls with scoliosis were also somewhat leaner. They did not deviate in age at menarche from normal girls in Sweden but there was a positive relationship between the age at diagnosis of the deformity and the age at menarche. When assessed together with previous data on the subject of height in children with scoliosis in Sweden it must be concluded that children with this deformity have a growth pattern which deviates significantly from that of the normal population.


The proportion of legs to trunk in girls with idiopathic structural scoliosis. The sitting height and its relationship to total height was compared for 164 girls with idiopathic adolescent structural scoliosis and 201 age-matched healthy controls. It was demonstrated that although girls with scoliosis were taller than controls the relationship between trunk and legs was undisturbed.


Late diagnosis dislocation of the hip joint in children. Dating from 1953, the hips of newborn have been examined routinely all over Sweden. In 1963 more than 99 per cent of all newborns (about 110,000) were delivered at maternity departments, where such examination was recommended. 615 cases of preluxation or dislocation were diagnosed, which means a frequency of 5.6 per thousand. A high frequency reported in some hospitals suggests overdiagnosis. To assess to what extent the examination of newborns has reduced the frequency of late diagnosis dislocation and dysplasia, extracts of the records were obtained concerning all infants born in 1963 and treated for dislocation of the hip in 1963-1966 at orthopaedic departments in Sweden. Twenty-seven reported cases were analysed and the children were reviewed after 4-10 years. Fourteen (52 per cent) of the children were found to have normal or practically normal hips at the review. Eight still had dysplasia with subluxation and 3 had substantially deformed joints, one had moderate deformity and one, untreated, still had luxation. Possible causes of late diagnosis are discussed and it is stressed -- that all physicians who examine newborns should be well versed in examination of the hip joints.--that the hip joints should, when possible, be examined on two occasions during the first weeks of life, especially newborns predisposed to dislocation owing to heredity, breech presentation or different kinds of malformations.--that it should be borne in mind that complete luxation, though rare, may exist already in the neonatal period,--that one should not forget to examine the hips of newborns who, because of prematurity, asphyxia etc., are referred immediately for intense treatment before routine examination of the hips has been carried out,--that a child health centes one should not rely on the results of the examination during the neonatal period, but should always examine the hip joints.


Middle ear specific proteins in glue ears. Two rabbits were immunized with a pool of mocoid secretion from glue ears. The ear fluids formed up to three specific protein precipitation lines with the absorbed immune serum. One of these proteins was identified as containing acid and another as containing neutral glycoproteins, the third component remained unidentified. The data bring out new evidence of the active secretory capacity of the middle ear mucosa in secretory otitis media.


Relationship between the vegetative innervation and the sensibility of the nasal mucosa. Experimentally and clinically, we observed that the parasympathicomimetic reaction of the nasal mucosa was congruent with higher sensitivity of the nasal mucosa. The opposite is true of the sympathicomimetic reaction. The reason for this difference in reaction is connected with the transmitting agent of the vegetative system. This is shown in the provocation of intradermal reaction of different allergens by these transmitting agents.


Nasal mucosa in the iron deficient state. A clinical and electron-microscopic study. Good results of iron therapy obtained in ozena patients with significantly lowered serum iron level encouraged studies on the pathogenesis of the disease. In electron microscopic examinations, special attention was paid to the considerable disintegration of connective-tissue stroma in the mucosa. In some connective-tissue cells ferruginous micelles were found in the mitochondrial matrix. Mitochondrial deposits may be a morphological expression of disturbed iron metabolism at subcellular levels.


Effect of physical exercise upon nystagmus and locomotor dysequilibrium after labyrinthectomy in experimental primates. Spontaneous nystagmus and locomotor equilibrium function were repeatedly tested before and after unilateral labyrinthectomy in 12 squirrel monkeys in order to study the effect of physical exercise on the vestibulo-oculomotor and vestibulo-locomotor compensation. Post-operatively, 6 of the monkeys received forced physical exercise in the rotating cage, while the other 6 did not. The provocation of post-operative spontaneous nystagmus was less in the exercise group. The statistical studies showed a certain contribution of physical exercise toward the oculomotor balance compensation and maintenance, probably at the level of the brain stem. Statistical comparison of the locomotor equilibrium performance did not depict a significant difference between the exercise and non-exercise groups; however, there was a possibility that the present testing maneuver which involves physically advanced tasks might have concealed the effect of the physical exercise.


Morphogenesis and ultrastructure of the mouse embryonic salivary gland in tissue culture. Normal, and following exposure to trypsin. The primordial submandibular glands of 12-day-old mouse embryos were studied in tissue culture before and after treatment with trypsin under the electron microscope. In vitro differentiation proceeded normally and reached a high level of differentiation. Following a soak in trypsin for 15 or 30 minutes, considerable changes were noted in the basal lamina and in the mesenchymatous cells. There often occurred bizarre bullous protrusions of the cytoplasm through the apparently weakened basal lamina and the mesenchymatous cells were converted into so-called "ropalocytes". Subsequently the cells regained their normal appearance and the basement lamina was covered by a thick layer of amorphous electron-opaque basement membrane like material. It is concluded that the basal lamina (the basement membrane under the light microscope) might be the keystone in the differentiation of an organ and its maintenance in the adult. The development of innervation has also been studied and it was shown that the developing submandibular galnd is endowed with large bundles of nerve axons surrounded by Schwann cells lying in the epithelial-mesenchymal region. Intra-epithelial nerves were conspicuous and occasional synaptic bars or rings could be seen contributing to thedifferentiation of the secretory cell.


The role of viral infection in acute peripheral facial palsy. Thirty-three patients with acute non-traumatic peripheral facial palsy were studied. In one patient, varicella-zoster virus was isolated from CSF. Antibody against the same virus was present in CSF, and rising titre was demonstrated in serum. In two cases, herpes virus hominis was isolated from the nasopharynx. CF-antibody tests indicated recent viral infection in 7 other cases. One additional patient had clinical signs of herpes zoster oticus. In most of these 11 patients, but also in the majority of the remaining 22 patients, an acute phase reaction was present, and serum and CSF immunoglobulins were increased. Thus, an active or recent infection (probably viral) seemed to precede or coincide with the facial palsy in most cases in both groups.


Ultrastructural study of the human utricular macula and vestibular nerve in meniére's disease. The authors have carried out an ultrastructural study of the human utricular macula and the vestibular nerve in the internal acoustic meatus of four patients suffering from Meniere's disease. They confirm the presence of degenerative alterations in the utricular sensory epithelium. The nervous fibers situated in the supporting connective tissue of the neuro-epithelium showed modifications in the Schwann cell cytoplasm and in the arrangement of the myelin sheaths. The same alterations appear in the vestibular nerve in the internal acoustic meatus in 2 of our cases. In the other 2, the vestibular nerve was formed by a granular matrix with several myelin figures in the proximity of possible Schwann cell nucleus debris.


Chronic glomerulonephritis accompanied by secondary hyperoxaluria. A 32-year-old woman, patient of chronic glomerulonephritis whose total clinical course was 3 years. During this period intensive peritoneal and hemodialyses were performed. Autopsy revealed deposition of calcium oxalate in the kidneys and the other main organs as well as chronic glomerulonephritis. And it was thought that the patient was accompanied by secondary hyperoxaluria.


Mechanism of the formation of megamitochondria induced by copper-chelating agents. I. On the formation process of megamitochondria in cuprizone-treated mouse liver. Processes of the formation of cuprizone-induced megamitochondria in mouse liver have been studied in detail by electron microscopy. The earliest change observed was the presence of large intramitochondrial granules. The next stage was the formation of myelin figures by which mitochondria were apparently connected. The third stage was characterized by megamitochondria connected with each other by their outer membranes. Continuity of mitochondria were further examined by serial sections, and megamitochondria were proved to be connected to each other far more frequentlythan expected on one plane of section. A model for the mechanism of megamitochondrial formation is proposed based on electron microscopic evidences, involving the fusion of mitochondrial membranes. Possibility is also discussed that cuprizone-induced megamitochondria may fuse to one single branching mitochondrion.


Auditory fatigue in patients with stapedius muscle paralysis. Experiments were performed in 18 patients with peripheral facial palsy (Bell's palsy) including unilateral stapedius muscle paralysis. After exposure to narrow band noise centered at 0.5 kHz temporary threshold shift at 0.75 kHz was significantly higher in the ear with paralysis than in the normal ear. After exposure to 2.0 kHz narrow band noise there was no difference in TTS at 3.0 kHz between affected and non-affected ear. It was concluded that the stapedius reflex has a protective function against low frequency sound exposure and suggested that this protection might be extended to higher frequencies only when high frequency noise also contains low frequency components.


Study of the variation of urinary protein patterns referring to the histopathological changes in renal diseases. Protein constituents of the concentrated urine prepared from 131 patients with various renal diseases were analysed by the use of electrophoretic and immunochemical methods, referring to histopathological findings of the kidney obtained from biopsy or autopsy. Excretion of macromolecular serum proteins in the urine would be promoted not only by the lesion in glomerular filtration but also by the damage in tubular structure due to severe inflammatory change. From the evaluation of levels of immunoglobulins and various autoantibodies in the blood and urine, there could be found that their increase in the urine was mostly associated with chronic persistent inflammatory reactions followed by destructive changes in parenchymal tissue of the kidney. Investigation of the features of urinary protein and activities of autoantibodies in the urine is likely to be advantageous for the differentiation or renal disease and the decision of condition in individual patient. However, it must be noted that variation of the urinary patterns is caused by more complicated pathologic changes in whole kidney rather than the disturbance of glomerular filtrating mechanism.


Normal and pathological adaptation of compound viii nerve responses in the guinea pig. Adaptation of VIII nerve compound action potentials in response to trains of broad frequency spectrum clicks and high frequency filtered clicks is studied at various intensities in normal guinea pig under normal conditions, while masking with white noise and under pathological conditions after ototoxic antibiotic treatment. The results are discussed with respect to the clinical electro-cochleographic adaptation studies in man and the so-called two populations of receptors and nerve fibres in the cochlea.


A human malignant cell line established from ascites of patient with embryonal carcinoma of ovarium. In our attempts at establishing a cancer cell line from various ascites of cancer bearing patients, a cell line was successfully established from the ascites of a 63-year-old female with primary ovarian tumor (embryonal carcinoma). Histological findings of the peritoneum, due to metastasis, appeared to be cystadenocarcinoma, revealing the differentiation to non-epithelial cells which formed coarse networks and fibers, and morphologic changes of tissue cultures also reflected such histologic findings. At present the subculture has reached the 95th population doubling level, and cultured cells have assumed the morphology of mesothelial cells or fibroblasts with about 50 chromosomes. As a human malignant cell line, it is useful for the study of human malignant tumor cell.


Flight behaviour of pigeons during weightlessness. Pigeons were subjected to weightlessness caused during parabolic flight in an airplane. Experiments were performed with these birds in their normal state, as well as in conditions with hooded eyes, with the legs bound, and a combination of both handicaps. In all these situations, the flight behaviour of the birds was observed. The results are discussed and comparisons are made with the behaviour of man and fish under similar conditions.


Some aspects of upper respiratory tract reflexes. Respiratory and cardiovascular reflexes have been elicited from receptors in the nose and larynx in the anaesthetized dog. Cigarette smoke in the nose causes reflex apnoea, bradycardia and vasoconstriction, probably due to systemic absorption through the nose. Stimulation of laryngeal nerve also results in reflex apnoea, bradycardia, and limb vasoconstriction. When asphyxia supervenes due to apnoea, stimulation of the carotid body chemoreceptors occurs which normally cause, as primary effects, hyperpnoea and bradycardia. However, it has been shown that stimulation of the laryngeal receptors inhibits the carotid body respiratory reflex and facilitates the carotid body cardio-inhibitory reflex, the latter leading to temporary cardiac arrest. The clinical implications of this finding are discussed.


Clearance of middle ear effusions by the mucociliary system. There are two extreme types of middle ear effusion leading to hearing loss (a) a rubber-like effusion seen in secretory otitis media and (b) a water-like effusion seen in serous otitis media. The possibility is considered that the degree of crosslinking in these two extreme cases is the basis of an altered mucus transport rate that leads to an accumulation of effusions and hence impaired hearing. It has been shown (King et al., 1974) that the requisite rheological property for transport activity is not unique to mucus structural macromolecules but is found with other polymeric systems that are loosely crosslinked e.g. guaran, polyacrylamide, gelatin and agarose. Studies on one of these systems guaran, indicate that the transport rate is dependent on the degree of crosslinking with a maximum rate found close to the gel point, i.e. in a region where there are very few crosslinks per macromolecule. The finding that mucus from different mucociliary epithelial sources involves a chemically similar structural glycoprotein suggests that differences observed in transport rate between various mucus samples are more likely due to differences observed in transport rate between various mucus samples are more likely due to differences in crosslinking than chemical variations of the glycoprotein units.


The role of the binaural test in filtered speech audiometry. The value of the binaural resynthesis test administered according to Matzker's principle can be estimated only when a comparable monaural test can be used as a control. The most common positive finding in the filtered speech test is asymmetrical discrimination. Both parts of the message delivered to either ear must therefore have the same intelligibility in normal material. Binaural intelligibility is highly resistant to degenerative changes in the auditory system, for example. Positive findings in the binaural test are encountered frequently in brain stem lesions with vascular or traumatic aetiology.


Resting potentials in the inner sulcus and tunnel of corti. Under constant visual guidance and closed-circuit television monitoring, electrodes are inserted into the fluid spaces of the organ of Corti. The resting electrical potentials are determined with respect to the neutral voltage of the guinea pig and related to other potentials of the auditory labyrinth. The resting potential of the subtectorial space, inner sulcus, tunnel and other spaces of Corti's organ are found to be the same as, or slightly more negative than the potential of perilymph. The tectorial membrane isolates the reticular lamina from endolymph which fact, when considered along with other evidence, indicates a more biophysical than mechanical role for the membrane. A motion picture is presented showing the cells and spaces of the organ of Corti and the placement of electrodes.


Electrocochleographic study of a case of lermoyez's syndrome. A case of Lermoyez's syndrome was investigated by tone-burst electrocochleography in both a period of impaired hearing and in a period of almost normal hearing. The changes in threshold values, compound action potential waveforms, input-output curves, and amplitude-latency curves for the compound AP, are described. The electrocochleographic data are compared with the psycho-acoustic data for this case and with electrocochleographic results in a group of 22 Meniere cases. Although the symptoms of vertogo and hearing impairment in Lermoyez's syndrome occur in the reverse sequence, as compared with the classical Menière attack, the data obtained in this case of Lermoyez's syndrome do not differ substantially from those obtained in a group of Menière cases.


Electrocochleography (ecog) in sensorineural deafness. We examined 340 normal ears and cases of sensorineural deafness with electrocochleography using click stimuli (duration: 0.5 standard deviation of a population; repetition rate: plus or minus 10/sec; N=1 000, alternately positive and negative; analysis time: 31 standard deviation of a population). The latency of N-1 is a function of the sound pressure level and of the age of the subject. The intensity of N-1 (in mu-v) is a function of hearing level and is influenced by the presence of recruitment. The pure-tone audiogram is a function of the ECOG threshold and of the shape of the reaction obtained at maximal stimulation intensity.


Electronystagmography in the pathology of the central nervous system. The program of the electronystagmographic examinations in the pathology of the central nervous system contains 11 groups of tasks. Sixty signs of central impairments are listed, from which 26 nystagmic irregularities had a small diagnostic value. No sign occuring alone could be taken as pathognomonic, only a group of signs can be used for the impairment localization. Besides for the peripheral vestibular and the peripheral vestibulocochlear impairments, the authors succeeded to make a group containing pathogomonic signs for mixed vestibular impairments as well as for multiple sclerosis affecting vestibular structures.


Non-psychotic disorders in the families of process schizophrenics. The present study was designed to test the hypothesis of "schizophrenic spectrum" disorders. The families of 60 process schizophrenics were systematically interviewed with structured interview forms, and evaluated for psychiatric illness according to strict diagnostic criteria. The interviewed persons were then separated into two groups for comparative analysis according to a positive (FH+) or negative (FH-) family history for schizophrenia. The frequencies of affective disorder and all non-psychotic conditions did not differ to a convincingly significant degree between the two groups. Our data thus fail to support the "schizophrenic spectrum" hypothesis in which neurosis and sociopathy occur as a consequence of a genetic loading for schizophrenia.?


Quantitative rating of depressive states. A step-by-step analysis of Beck's and Hamilton's rating scales showed that both scales failed to differentiate adequately between moderate and severe depression measured by a global clinical assessment. Each item of the scales was tested for calibration, ascending monotonicity, and dispersion parallel to the clinical assessment. Twelve items of Beck's scale and six items of Hamilton's scale were found valid with respect to these criteria. Those items should be taken into account in future research for baseline ratings and for change ratings of depressive states quantitatively.


Mind and ulcer.

Mind and ulcer. Among 2,619 patients admitted to a medical department for duodenal ulcer, gastric ulcer and ulcer dyspepsia without ulcer demonstrable by x-ray, admissions to psychiatric departments were investigated. A total of 20.4% of the patients had at some time during their lifetime been admitted, but no significant differences were observed in percentage among the three ulcer groups or the sexes. The incidence of psychoses was close to the expected, whereas neuroses among women and neuroses and psychopathy among men were far in excess of the expected. Among those operated on, the percentage of persons admitted to a psychiatric department was greater than among unoperated patients and their number of admissions per 100 observation years were significantly greater than for unoperated patients, within well-defined observation periods. For patients operated on, only men with duodenal ulcer had significantly more admissions per 100 observation years in the postoperative than in the preoperative period. The course of the disease was more severe for patients with duodenal and gastric ulcer admitted to a psychiatric department than for those not admitted, but the subjective status at the time of the follow-up did not differ between the two groups. Among men, there were a number of heavy drinkers, especially among those operated on.


Presenile dementia: the difficulties of early diagnosis. A follow-up of 35 patients first diagnosed as having presenile dementia at York Clinic is described. In only 15 cases did progressive deterioration confirm the diagnosis. A retrospective case note study of all the patients is described comparing the clinical features and results of special investigations of those patients in whom the diagnosis was confirmed in this way and those in whom it was not. The results of this study are used to illuminate some of the special difficulties in the early diagnosis of presenile dementia.


Resection of lef ventricular aneurysm-late results. A survey of 22 patients operated on with left ventricular (LV) infarctectomy during 1967-72 is given. Clinical, haemodynamic and angiographic results are discussed. In most patients, in whom pre- and postoperative examination was possible, there was improvement concerning anginal pain, dyspnoea and attacks of ventricular tachycardia. Exercise studies revealed a lower heart rate at follow-up. In general, heart size had decreased. Angiographically, there was a decrease in end-diastolic and end-systolic heart volume postoperatively, with an increased LV ejection fraction.


Diazepam in cardioversion.

Diazepam in cardioversion. Diazepam has been used to an increasing extent in cardioversion, since avoiding general anaesthesia simplifier the procedure. The present study concerns the effect of diazepam on BP and blood gases in 13 cases of cardioversion. A moderate fall of both systolic and diastolic BP occurred. The arterial pO2 and pCO2 did not change significantly.


Renal excretion of vancomycinin in kidney disease. The renal climination of vancomycin has been determined in 18 patients. In 4 anuric patients in intermittent haemodialysis the dosage of vancomycin necessary to treat infection with penicillin-resistantstrains of Staphylococcus aureus was determined. In 14 patients with varying degrees of renal insufficiency vancomycin, creatinine and 125-iothalamate clearances were measured and found to be closely correlated. After administration of the initial vancomycin dose and attainment of the serum concentration desired, the maintenance dose can be calculated on the basis of the GFR.


Monoclonal immunoglobulinaemia associated with glomerulopathy. Four patients with benign monoclonal immunoglobulinaemia and associated glomerulopathy are described. Immunohistochemical investigations of the immunoglobulin-containing cells in the bone marrow revealed an unexpectedly pronounced predominance of monoclonal over polyclonal cells as typically seen in macroglobulinaemia and multiple myeloma, but in contrast to the malignant plasma cell proliferations the percentage of immunoglobulin-containing cells only constitued 6-12% of the nucleated cells. The possible pathogenetic mechanisms relating monoclonal immunoglobulinaemia and glomerulopathy are unknown. The sera did not contain antibodies to glomerular basement membrane, cryoglobulins, antinuclear factors or antiglobulins. The immunohistochemical technique certainly offers a clear advantage over conventional bone marrow cytology in the study of patients with monoclonal immunoglobulinaemia.


The effect of norepinephrine and theophylline on blood glucose, plasms FFA, plasma glycerol and plasma insulin in normal subjects. The plasma concentrations of free fatty acids (FFA), glycerol and insulin as well as the blood glucose concentration have been followed in two groups of subjects after infusions of theophyllamine. Each individual was examined twice. The 5 subjects in group  2 were given an infusion of norepinephrine before the theophyllamine at one of the examinations and saline at the other. The 6 subjects in group II were given an infusion of norephinephrine at both examinations, followed by theophyllamine on one occasion and by saline on the other. Thus, the subjects in both groups served as their own controls. It was found that theophyllamine caused lipid mobilization, as measured by the plasma FFA and plasma glycerol concentrations, both when given as the only active drug and when given after norepinephrine. The blood glucose concentration rose slightly after norepinephrine and the plasma insulin level increased concomittantly. When theophylline was given as the only active drug, there was no increase in the blood glucose but the plasma insulin concentration rose slightly.


Portal and cubital serum insulin during oral, portal and cubital glucose tolerance tests. Oral, intracubital, and intraportal glucose tolerance tests have been performed on 7 non-obese non-diabetics, and glucose and insulin concentrations have been followed in the peripheral and portal blood. A significant rise in portal glucose and insulin was found 1/2-2 min after oral glucose intake. There was no lag between the rise in insulin and glucose concentrations. The portal glucose concentration after oral glucose intake was significantly higher than after cubital glucose infusion for 45 min, although the peripheral glucose concentrations were identical. In the cubital vein the insulin concentration after oral glucose intake was significantly higher than after i.v. glucose infusion, but in the portal blood there was no difference. After portal glucose infusion the cubital insulin concentration did not differ significantly from the concentration after i.v. glucose infusion. Thus, it seems unlikely that a high portal glucose concentration is responsible for the higher peripheral insulin concentration after oral glucose intake. A high portal glucose concentration does not seem to influence the hepatic uptake or release of glucose.


Removal of exogenous triglycerides in human forearm muscle and subcutaneous tissue. The removal of exogenous triglyceride (TG) in forearm muscle and subcutaneous tissue of 7 healthy male volunteers has been studied by nephelometric determinations of arterial-deep venous (a-dv) and arterial-superficial venous (a-sv) differences in concentration of fat particles. Exogenous TG was administered as a constant i.v. infusion of Intralipid over a period of 30 min at reat and another 15 min during forearm work. At rest a significant positive a-dv difference in fat particle concentration of 121 plus pr minus 21 mumol TG/l (mean plus or minus  S.E.M.) was found, which correspondens to a fractional extraction of 1093 plus or minus 2.0%. Also the a-sv difference was significant, 81 plus or minus 14 mumol TG/l, 5.7 plus or minus 0.8% of the arterial concentration. During exercise no further significant removal was found. Thus both skeletal muscle and subcutaneous tissue seem to be able to remove exogenous TG in substantial amounts under resting conditions. In the exercising muscle, however, the direct removal of exogenous TG does not seem to be of significant importance.


Association between a low adipose tissue content of polyunsaturated fatty acids and both glucose intolerance and hypertriglyceridemia in apparently healthy men. The fatty acid spectrum of adipose tissue (AT) lipids has been determined in 43 apparently healthy men with different levels of plasma triglycerides (TG) and different degrees of glucose tolerance (GT). Compared to men with normal plasma TG levels those with hypertriglyceridemia (HTG) had a similar percentage of linoleic acid (18:2) but lower amount of fatty acids, tentatively identified as linolenic (18:3) and arachidonic (20:4) acid. Men with HTG also had lower k-values for the i.v. GT. The content of 18:3 and 20:4 was positively correlated to the k-value of the GT and negatively to plasma TG. These correlations were independent of each other. As usual there was a negative correlation between plasma TG levels and the k-value, which however disappeared after partial correlation analysis when 18:3 was kept constant. Apparently a low content of 18:3 in AT is common both in HTG and glucose intolerance (GI) and might partly explain the often seen association between these two metabolic abnormalities. Since the content of 18:2 was normal it is suggested that the low amount of 18:3 and 20:4 was caused by metabolic rather than dietary factors. The possibility that a low content of 18:3 and 20:4 might play a role in the pathogenesis of GI and HTG is discussed.


Polymorphic acetylation of procaine amide in healthy subjects. The acetylation of procaine amide has been studied by means of gas liquid chromatography in 33 healthy human volunteers. The acetylator phenotype was determined by measuring unchanged and acetylated sulphapyridine in urine. Slow acetylators of sulphapyridine excreted significantly less procaine amide in acetylated from in the urine than rapid acetylators (9 plus or minus 1% against 19 plus or minus 4%). Hence, it is suggested that the acetylation of procaine amide is subject to the same genetic polymorphism as that of isoniazid and some sulfonamides.


Acetylator phenotype and the antihypertensive response to hydralazine. Twenty-three out-patients with mild or moderate essential hypertension have been treated with a combination of hydralazine (37.5-150 mg daily) and oxprenolol (60 mg daily). Before treatment the patients were phenotyped for polymorphic acetylation by means of the sulphamethazine test: 12 proved to be slow and 11 rapid acetylators. A significant correlation was found between daily doses of hydralazine and the plasma hydralazine levels, separately in slow (r=0.480) and in rapid (r=0.580) acetylators. The antihypertensive response to hydralazine correlated well to plasma hydralazine levels. The mean fall of BP in slow acetylators was 33/23 mmHg in supine and 20/18 mmHg in standing position. The corresponding values in rapid acetylators were 22/15 and 21/15 mmHg. The average daily doses of hydralazine needed for these responses were 1.3 mg/kg in slow and 1.6 mg/kg in rapid acetylators. To reduce the systolic BP by 20 mmHg, 1.0 mg/kg of hydralazine was needed in slow acetylators; rapid acetylators needed a significantly higher dose of 1.4 mg/kg. During a follow-upof 1 year there have been virtually no side-effects. The results tally with the previous finding of Zacest and Koch-Weser, who demonstrated a similar correlation during the triple-drug regimen. It seems as if hypertensive patients can be succesfully treated with hydralazine and beta-blocking drug without knowledge of the patient's acetylator phenotype. However, acetylator status is a determinant of tissue levels and long-term toxicity of hydralazine, and patients should be phenotyped because beta-blockers may mask the warning side-effects.


The urinary excretion of trace elements before and during treatment with hydralazine. Urinary excretion of antimony, arsenic, bromine, cadmium, caesium, cobalt, copper, gold, iron, mercury, molybdenum, ribidium, scandium, selenium, silver, tungsten and zinc from five hypertensive patients beforeand during treatment with hydralazine has been investigated. The method consisted of neutron activation analysis combined with a recently developed ion exchangee technique. The mean copper excretion during treatment with hydralazine was found to be more than twice that before treatment.


Fever and haemolysis in Hodgkin's diseases. One hundred and four patients with Hodgkin's disease have been studied retrospectively in order to evaluate the relationship between fever associated with the disease (Pel-Ebstein type) and the development of anaemia. In the material 19 episodes of fever were found to be of this type. The mean loss of Hb during a fever period was 14% (range 2-33). From the rate of decrease in Hb it was deduced that this was at least partly caused by an increased destruction of erythrocytes. There was a significant correlation between the thermal exposure (expressed either as the duration of fever, the maximum body temperature during the fever period, or the sum of the temperature maxima) and the degree of erythrocyte loss. The loss of Hb was self-limited in spite of persistent fever. Furthermore, there seemed to be an inverse relationship between the degree of preexisting anaemia and the fever-induced relative loss of Hb. A possible explanation is that the older part of the erythrocyte population is more sensitive to the effect of fever.


Therapeutic effect of Leo 1031, an alkylating corticosteroid ester, in lymphoproliferative disorders. I. chronic lymphocytic leukaemia. Leo 1031, a chlorambucil ester of prednisolone, has been administered orally to 15 patients with chronic lymphocytic leukaemia (CLL) continuously for 1-29 months (mean 12.5). Seven patients were previously untreated and eight had been treated with prednisolone, radiotherapy and/or alkylating agents. The initial daily dose was generally 8-16 mg and the maintenance dose was 6-8 mg. Allopurinol was given concurrently. In 14 of 15 patients a reduction of the leucocyte count was observed and a reduction, in most instances, of lymphadenopathy or splenomegaly, or both. In seven patients the Hb concentration was improved. Significant toxic effects on bone marrow function have been observed in one patient. Two patients developed urticaria. Our study suggests that the drug is effective in the treatment of CLL.


Renin-secreting renal tumour with severe hypertension. case report with tumour renin analysis, histopathological and ultrastructural studies. A 25-year-old man presented with severe hypertension associated with hypokalemia, elevated plasma renin level and secondary hyperaldosteronism. Malignant phase hypertension and renal artery stenosis were ruled out, and a preoperative diagnosis of renin-secreting renal tumour was made on the basis of higher concentrations of renin in the left than in the right renal venous plasma in spite of normal findings on selective renal arteriography. By removal of the affected kidney the tumour was found and it had a very high content of renin. Following the operation the plasma renin level, serum aldosterone concentration and BP became normal. We present a histopathological description and an ultrastructural study of the tumour.


Prefrontal lesions and avoidance reflex differentiation in dogs. The effects of bilateral partial prefrontal lesions on go-no go differentiation with symmetrical or asymmetrical reinforcement trained by the avoidance procedure were investigated. Moderate impairment of these tasks was observed after large lateral or medial prefrontal lesions, while severe impairment after a deep incision of the fibers in the specific prefrontal region. It is suggested that the mechanism of avoidance differentiation is of a symmetrical type, which is directly related to the "motor act differentiation" but not to the drive-no drive differentiation.


Salivary reactions in dogs with dorsomedial amygdalar lesions. In dogs with chronic parotid fistula, conditioned salivary reactions reinforced by food were established. After bilateral lesions of the dorsomedial part of the amygdaloid complex, the conditioned salivary reactions were greatly diminished. Also the unconditioned salivation decreased. This decrease was greater in dogs which revealed the whole syndrome of amygdalar aphagia, but it was also evident in hypophagic dogs. In some dogs, the disinhibition of the salivation to negatives CS was also observed. Results show that the dorsomedial amygdala, similarly to lateral hypothalamus, is involved in the regulation of salivary reactions.


A failure to train the "same-different" differentiation of photic stimuli in dogs. Dogs were unable to learn "same-different" differentiation of pairs of photic stimuli when continuous light (CL) and pulsing light (PL) were presented in four combinations: CL-PL and PL-CL served as S(D) (positive instrumental conditioned stimulus), whereas CL-CL PL-PL were S delta (inhibitory stimulus). Also the dogs which have learned this task with tones were unable to transfer to photic stimuli. Differentiation of the single stimuli (CL and PL) as S(D) and S(delta) was quite easy and showed that the stimuli were readily discriminable.


Transfer of the "same-different' differentiation task in dogs. Four dogs, previously trained to perform on the "same-different" differentiation with tones transfered readily to the same task with new stimuli of the same (auditory) modality. The data are interpreted as an support for the "matching" hypothesis and a disproof of the notion of "conditioned switching".


Light-sound interaction in the neurons of the rabbit's visual cortex. One hundred cells of the visual cortex were studied using flashes, clicks and light-sound combinations with different delays. Forty nine neurons changed the total number of spikes to click stimulation. Twenty eight cells responded to clicks with specific response pattern. In 23 cells the initial discharge occurred at 60-70 ms after the onset of clicks. In 39 cells the responses to light-sound combinations differed from the responses to flashes. While 16 cells decreased their responses, the addition of sound increased firing in 23 cells. The specific modification of the light-evoked responses under acoustic stimulation were classified into three main categories: 22 cells generated new response patterns, 18 cells showed a re-distribution of peaks in the PTS histogram and three cells demonstrated a desynchronization of the spike discharge. The study of the heteromodal recovery cycle revealed that the majority of the cells increased their firing during 0-100 ms and decreased firing during 200-300 ms of the response time scale. The critical delays between light and sound, resulting in the modification of the response for the majority of the cells, were within 100 ms in both directions.


Single-unit responses to natural objects in area 19 of cats with different early visual experiences. Cats deprived of pattern vision with hoods and normal cats were used. During the first 3 months of life some hood-reared cats had visual experience with a three-dimensional cross or a ping-pong ball. Recording were performed in adult cats with a pretrigeminal brainstem transection. Unit responses to the cross and the ball were recorded in area 19 within the projection of area centralis. Stimulus-dominance of the exposed object was manifested weakly. Both exposed and control objects activated more units in the experienced hood-reared cats than in hood-reared and normal controls. Compared with previous finding, the present results indicated that early visual experience affects area 19 differently than areas 17 and 18.


Kinins and central effects of the acetylcholine. The interaction between kinins formed in central nervous system and acetylcholine was studied. Endogenous ACh in excess acted psychodepressively on the animal's behavior as evaluated with Lat's test. This effect was more intense in those rats in which the activity of kinin-forming enzymes in the nervous tissue had been increased with either kallikrein or bradykinin. Both kallikrein and bradykinin intensified the psychodepressive action of exogenous ACh given into the brain ventricle. Results show that kinins can enhance the inhibitory central action of ACh.


The effects of trypsin-degradation products of albumin on the activity of the central nervous system. The investigations deal with the pharmacological activity of albumin degradation products. The peptides which resulted from 30 min trypsin digestion of human albumin exhibited some kinin-like effects. The peptides given intraperitoneally and intraventricularly revealed a central inhibitory action, the strength of which was similar to kinin effects.


Contribution of the his bundle recording to the diagnosis of bilateral bundle branch conduction defects. The participation of intraventricular conduction defects in the AV delays and blocks has been investigated by His bundle electrogram recording in 239 patients with different degrees of AV blocks and QRS enlargement (greater than 0.12 sec). In absence of PR prolongation, the His bundle electrogram can demonstrate intraventricular conduction delay (HV superior to 55 msec) with an increasing frequency in right bundle branch block and right bundle branch with left axis deviation, left bundle branch block and right bundle block with right axis deviation. In cases of first-degree AV block (PR greater than 0.20 sec) delay within the His bundle is present in 20% of the cases and HV prolongation, isolated or associated with an upper conduction defect is demonstrated in 66% of the cases. Second-degree AV block with QRS enlargement in the conducted beats is due to a subnodal lesions of the conducting tissue in 80% of the cases. Wenckebach phenomenon and bundle branch block is as frequent above as below the site of His bundle electrogram recording. Möbitz II block has always an infranodal localization. Third-degree AV block with wide QRS complexes is the consequence of a lesion within the His bundle in 11% and of a complete bilateral bundle branch block in 78% of the cases. Exploration of the AV conduction in acute myocardial infarction with AV block confirms the usual bilateral bundle branch lesion in anterior myocardial necrosis and the AH localization of the AV block in posterior myocardial infarction even in presence of enlarged QRS complexes. Unidirectional block occurs in 19 of the 82 cases of complete anterograde bilateral bundle branch block, with retrograde conduction to the atria in 11 and concealed retrograde conduction in 8 cases.


Mechanisms determining the ventricular rate in wolff-parkinson-white arrhythmias. In patients with WPW syndrome the maximal ventricular rate attained during ectopic rapid supraventricular thythms depended on the type of arrhythmia as well as on the physiological properties of the AP. During reciprocating tachycardias the impulse is almost invariably conducted to the ventricles through the AV node. Therefore, the maxiaml ventricular rate is a function of the AV nodal ERP. On the other hand, when atrial flutter or atrial fibrillation were present the ventricular rate could be moderately elevated (when the ERP of the AP was longer than that of the AV node) or very rapid where the ERP of the AP was significantly short. Therefore, from the electrophysiological viewpoint, the AP appears to behave as His-Purkinje tissue in some cases and as ordinary artrial muscle in other patients. These assumptions await further documentation.


Effect of drugs in the wolff-parkinson-white syndrome. Electrical stimulation of the heart, using the single test stimulus method, gives the opportunity to study the mechanisms of tachycardias and the effect of drugs on these mechanisms directly in the heart of the patient with the WPW syndrome. Using these methods the effect of digitalis, procainamide, quinidine, ajmaline, lidocaine, propranolol and verapamil has been studied. Understanding of the mechanisms responsible for initiation and maintenance of tachycardias and the way in which they can be influenced by drugs should be of help in the treatment of the symptomatic patient with the WPW syndrome.


Computer analysis of ventricular conduction defects. Computer criteria for LAHB and LPHB were described together with limits of normal for ortogonal leads. These differ significantly from those used for conventional 12-lead ECG, indicating the need for specific LAHB and LPHB criteria in orthogonal electrocardiography. Multivariate analysis with a likelihood ratio test was used for the separation of records with conduction defects with and without MI. The total number of records was 847. The recognition rate for MI in the presence of LVCD was 66%. In the presence of RVCD, MI was diagnosed correctly in only 55%. This relatively poor result was probably due to the relatively large number of combinations of RCVD with LAHB or LPHB.


Complete left bundle branch block with marked left axis deviation of qrs clinical and anatomical study. In a series of 840 cases of unselected complete LBBB, 2 groups were compared with each other, one of 174 cases of complete LBBB with a QRS axis markedly deviated leftward, from minus50 to minus 90 degree (group A), the other 434 complete LBBB with a normal QRS axis included between minus20 and plus30 degree (group B). Group A differed from group B by the etiological predominance of primary cardiomyopathies, the lesser frequency of hypertensive and/or coronary heart disease, the rarity of idiopathic complete LBBB. It was commonly combined with marked enlargement of the X-ray heart shadow, with marked widening of QRS complex and had a definitely more severe prognosis. The anatomical study performed in 88 cases (52 group A, 36 group B) showed on thw whole a slightly more enlarged heart and a more marked left ventricular dilatation in group A. There were no differences in the state of the coronary arteries and in the frequency of myocardial infarction. Microscopical examination of the left bundle branch, performed in 42 cases (25 group A, 17 group B), showed the habitual and intense changes of the bundle branch, but without obvious difference between the 2 groups concerning the topographical distribution of the lesions.


Mechanism of action of antidysrhythmic drugs on ventricular conduction as studied with intramural electrodes. Using the Dürrer electrode needle to record the intramural electrogram and a standard peripheral electrocardiogram (ECG) lead as reference, the authors studied the action of 9 different drugs in the conduction system of dogs. The authors concluded that diphenylhydantoin and lignocaine would be useful in dysrhythmias related to increased excitability and perhaps increased automatism. Ajmaline and quinidine may be some of some interest in dysrhythmias due to conduction disturbances; and, finally, ajmaline, diphenylhydantoin, di-isopyramide and quinidine may be useful in dysrhythmias due to focal re-entry.


Concealed intraventricular conduction in the human heart. Concealed intraventricular conduction is defined and the following classification of the manifestations of concealed conduction into the bundle branch system is proposed. 1. Trans-septal retrograde concealed intraventricular conduction responsible for (a) perpetuation of functional bundle branch block initiated by a premature supraventriculra impluse; (b) alternation of aberrant ventricular conduction in supraventricular bigeminy; (c) normalization of intraventricular conduction with acceleration or rate in bradycardia-dependent bundle branch block, and (d) prevention of the manifestation of Wenchbach periods of conduction in a bundle branch or fascicle. 2. Antegrade concealed intraventricular conduction responsible for (a) prevention of expected aberrant ventricular conduction when a short cycle follows a long one, and (b) exceptions to the "rule of bigeminy". 3. Retrograde concealed intraventricular conduction of a ventricular escape in association with unidirectional bundle branch or fasciular block responsible for (a) resumption of AV conduction in "paroxysmal AV block" with bundle branch block, and (b) facilitation (due to supernormality) of conduction in type II AV block due to bilateral bundle branch block. 4. Concealed intraventricular conduction of a premature ventricular impulse responsible for (a) initiation or termination of a re-entrant ventricular tachycardia; (b) resetting of an idioventricular pacemaker, and (c) pseudo-intraventricular or pseudo-AV block.


Electral stimulation of the heart in the study of ventricular tachycardias. Mechanisms of ventricular tachycardia in patients with chronic recurrent tachycardia and patients with acute myocardial infarction were studied by electrical stimulation of the heart. While re-entry was the most likely mechanism in chronic recurrent ventricular tachycardia, focal activity or re-entry in a very small area seemed to be responsible for ventricular tachycardia during acute myocardial infarction.